Provider Demographics
NPI:1790361954
Name:HALLINAN, KELSEY (DNP, APRN)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:
Last Name:HALLINAN
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2660 REIDVILLE RD UNIT 1
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-3512
Practice Address - Country:US
Practice Address - Phone:864-560-9696
Practice Address - Fax:864-560-9636
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24804207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP7456Medicaid
SCSCJ8696067OtherMEDICARE PIN